Congenital heart disease physical examination

• Tachycardia may be present

• Tachypnea may be present

• Retinopathy

• Wheezing may be present

• Precordial bulge may be present

• Thrill due to outflow tract obstruction or a restrictive ventricular septal defect
• Increased apical activity suggestive of left ventricular volume or pressure overload

• A single second heart sound occurs in the following conditions:
  • Aortic atresia
  • Pulmonary atresia
  • Truncus arteriosus
  • Conditions with pulmonary hypertension

• Widely or fixed split S2 occurs with atrial septal defect

• Early systolic clicks, which occur with semilunar valve stenosis, bicuspid aortic valve, and truncus arteriosus.

• Mid-systolic clicks, which are heard with mitral valve prolapse and with ebstein’s anomaly of the tricuspid valve.

• An S3 gallop, which, in infants, can result from ventricular dysfunction

• Murmurs
  • Atrial septal defect: Systolic murmur heard best at the left upper sternal border
  • Ventricular septal defect: Holosytolic murmur heard best at the left upper sternal border
  • Patent ductus arteriosus: Machinery murmur heard best in the left infraclavicular region
  • Tetralogy of fallot: A harsh systolic ejection murmur best heard at the left sternal border is usually present.
  • Persistent truncus arteriosus: Systole ejection murmur is heard at the left sternal border
  • Transposition of the great vessels: The murmur of a large PDA in d-TGA, is usually systolic, seldom continuos, due to the almost exclusive flow during systole from the aorta to the pulmonary artery. Systolic murmurs are absent in neonates unless a subpulmonic stenosis is present
  • Total anomalous pulmonary venous connection: Systolic ejection murmur is heard at left upper sternal border. Diastolic murmur due to tricuspid regurgitation is also heard.

• Hepatomegaly often occurs in patient with congestive heart failure.

• Cyanosis

• Clubbing

• Skeletal abnormalities, especially those of the hand and arm, are often associated with cardiac malformations.

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